The value of kinetic glomerular filtration rate estimation on medication dosing in acute kidney injury

• Published in: PloS one 2019-11, Vol.14 (11), p.e0225601
• Main Authors: Kwong, Yuenting D, Chen, Sheldon, Bouajram, Rima, Li, Fanny, Matthay, Michael A, Mehta, Kala M, Glidden, David V, Liu, Kathleen D
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - physiopathology; Adult; Adult respiratory distress syndrome; Aged; Algorithms; Biology and Life Sciences; Catheters; Chronic kidney failure; Clinical trials; Creatinine; Creatinine - blood; Critical care; Critical Illness; Discordance; Drug dosages; Drugs; Engineering and Technology; Epidemiology; Epidermal growth factor receptors; Estimates; Estimation; Female; Glomerular Filtration Rate; Hemodialysis; Humans; Kidney diseases; Kidney Function Tests - methods; Kidneys; Kinetics; Male; Medicine; Medicine and Health Sciences; Methods; Middle Aged; Nephrology; Pharmaceuticals; Population; Pulmonary arteries; Renal function; Renal Insufficiency, Chronic - physiopathology; Respiratory distress syndrome; Toxicity; Transplants & implants; Variation
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0225601

In acute kidney injury (AKI), medication dosing based on Cockcroft-Gault creatinine clearance (CrCl) or Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rates (eGFR) are not valid when serum creatinine (SCr) is not in steady state. The aim of this study was to determine the impact of a kinetic estimating equation that incorporates fluctuations in SCrs on drug dosing in critically ill patients. We used data from participants enrolled in the NIH Acute Respiratory Distress Syndrome Network Fluid and Catheters Treatment Trial to simulate drug dosing category changes with the application of the kinetic estimating equation developed by Chen. We evaluated whether kinetic estimation of renal function would change medication dosing categories (≥60, 30-59, 15-29, and